Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 011191 | LA |
NPI | 1033170303 |
---|---|
Provider Name | Bernard E Patty |
First Address | Alexandria, LA 71303 |
Second Address | Alexandria, LA 71303-3538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 27/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1154369 | (05) | LA |
B65317 | (02) | |
P00169986 | TRAVELERS MEDICARE (01) |